Basic Information
| Provider Information | |||||||||
| NPI: | 1558323337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOLLER | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.T. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NUTTALL | ||||||||
| OtherFirstName: | MEGAN | ||||||||
| OtherMiddleName: | LEE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | D.P.T. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2775 SCHOENERSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108618080 | ||||||||
| FaxNumber: | 6108070366 | ||||||||
| Practice Location | |||||||||
| Address1: | 2775 SCHOENERSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180177307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108618080 | ||||||||
| FaxNumber: | 6108070366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 12/10/2010 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT018023 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7234822 | 01 | AETNA PPO | OTHER | 1837981 | 01 | HIGHMARK BLUE SHIELD | OTHER | 2170544 | 01 | MAMSI | OTHER | 2693619000 | 01 | KEYSTONE HEALTH EAST | OTHER | 427548 | 01 | HEALTHAMERICA/HEALTHASSUR | OTHER | 47241 | 01 | GEISINGER HEALTH PLAN | OTHER | 50058560 | 01 | CAPITAL BLUE CROSS | OTHER | 1837981 | 01 | FIRST PRIORITY LIFE INS | OTHER | 2693619000 | 01 | AMERIHEALTH | OTHER | 50058560 | 01 | KEYSTONE HEALTH CENTRAL | OTHER | P00354751 | 01 | MEDICARE RAILROAD | OTHER | 820177 | 01 | FIRST PRIORITY HEALTH | OTHER | 2734665 | 01 | UNITED HEALTHCARE | OTHER | 8614788 | 01 | CIGNA HEALTHCARE | OTHER | P3686991 | 01 | OXFORD HEALTH PLANS | OTHER | 2693619000 | 01 | INDEPENDENCE BLUE CROSS | OTHER |